Nursing: Best Practices

Although the phrase and concept of “Nursing: Best Practices” has become largely popular in recent times, several nurses are still unaware of the real meaning. Today, the most widely accepted definition is that the best practices are those patient care practices that have been put into practice as the result of nursing research. As you might be aware, there are other phrases in use that are interchangeable to this. They are “research utilization”, “research-based practices”, “evidence-based practices” and so on. At present, almost all the nursing programs from RN to BSN include courses on nursing best practices. Let's discuss more on the topic.

Goals of nursing best practices

The primary objective of best practices is to implement the most recent, appropriate, and useful nursing interventions that have their base on nursing research in real-life nursing practice. The expected results of nursing best practices will be the desired patient outcomes in different settings, as well as geographical locations.

Why do you want to instill nursing best practices?

The concept of best practice in nursing is really important. As we are well-aware, new knowledge based on nursing and other related interdisciplinary research is seeing a dramatic expansion. The supply of high-quality patient care would depend on the ability to translate research-based knowledge into real-life nursing practice. Unfortunately, the methods to acquire knowledge by nurses in the past like attending meetings and conferences, networking with other nurses and reading nursing and other medical journals can merely keep pace with the range of potentially useful practice-related reports.

Therefore, in order to acquire updated knowledge about the best practices in nursing, you need to learn about it regularly. It’s to be noted that the evidence-based practice would provide us the opportunities for nursing care to be more customized, efficient, streamlined, as well as dynamic. Furthermore, the best practices would help maximize the effects of the clinical judgment.

Nursing best practices – here's an example:

The best practices for fall reduction in patients can be quoted as the perfect example of nursing best practice today. It’s to be noted that preventing falls in patients is the highest priority for every nurse in health care organizations. Almost every nurse would recall at least one incident in which a patient fell or at least nearly fell. And the culture of safety doesn’t motivate the nurses to work toward change. It wants them to take appropriate action when they see something wrong. We can say that this culture doesn’t have a place for those who say safety isn’t his or her responsibility. Eventually, pressures would come from all the angles.

The health care organizations could decrease patient falls if the leaders in the organizations are committed towards change and thereby, allowing staff to openly speak out their safety concerns without the fear of reprisal or retaliation. When there is no such culture in an organization, nurses will not show interests to document events and/or safe circumstances that could lead to patient falls. You might be thinking that culture will not bring a change. Remember, a culture change would take a long time.

The reason for having nursing best practices

So, why do we want to have best practices for nurses? The reasons for developing and implementing best practices are as follows:

For achieving better patient outcomes

For saving and reducing costs

For disseminating information about patient care

For meeting the challenges of escalated consumer knowledge about therapies and patient care options

Best practice vs. evidence-based practice

Although the phrases “best practice” and “evidence-based practice” are used interchangeably today, these two are different in some aspects. To put it simply, we can say that the best practice is a generic/general phrase that is being said for a process of instilling nursing practice with research-based knowledge. On the other hand, the evidence-based practice evolves from evidence-based medicine and can be defined as the thorough, exclusive, and sensible application of present best evidence in making decisions when it comes to patient care. In this line, the practice of evidence-based medicine would mean the integration of individual clinical skills with the best available clinical evidence made through systematic research.

Thus, we can say that the phrase “systematic research” is the key to differentiating evidence-based practice and best practice. So, what do you mean by systematic research? This phrase would imply us various things. Firstly, it signifies the use of research that is well-structured and rigorous. This would also denote the use of results and findings that have been supported by a group of research studies.

Remember, systematic reviews are different from our conventional literature reviews in various ways. The former are the ones that are more comprehensive in scope, utilize pre-set criteria to rank the quality of research that is being reviewed and would utilize the randomized clinical trials as the gold standards through which evidence is determined.

Nursing best practice is best practice for patients

A recent report that has documented the effect of hospital practice on the hiring and retention of nurses has also stated that the best practices for nurses will be best for patients too. The report starts with the strong point that the practices that are creating a positive working atmosphere for nurses are critical in securing higher standards in quality patient care. The decline in quality patient care is one of the major complaints made by nurses who are struggling to sustain in the healthcare sector.

A recent survey that was conducted showed that almost 75% of RNs think that the quality of nursing care that is offered by their facility has deteriorated over the past couple of years. Among them, almost 68% stated that staffing levels are the major contributing factors to the problem. In a similar five-country survey that was conducted recently, almost 44.8% of U.S. nurses stated that the quality of their facilities in their organizations had declined during the past year.

In a greater part, the root causes of these issues can be dated back to the dynamics that weakened the working standards for registered nurses. During the year 1999, the “American Organization of Nurse Executives” found out a devastating increase in the frequency of nursing practice problems contributing to detrimental patient outcomes. Upon analyzing these incidents, we were able to identify that the most common issues resulted from one of the following nursing actions:

Failing to monitor and evaluate the changing patient’s status

Failing to correctly note down findings

Failing to communicate effectively

Success of RNs

A more comprehensive study was conducted to find out the association between staffing levels and patient outcomes. This study, which included data from over five million patient discharge records from 800 hospitals in eleven states, found that the higher proportion of hours of nursing care offered by the RNs and the higher number of hours of care offered by RNs per day are associated with enhanced care for in-patients. Thus, researchers found a powerful and constant association between nurse staffing and outcomes in patients. As such, there was a significant reduction in the rates of adverse outcomes.

In an another study, the ratio of registered nurses to patients and the skill fusion between registered nurses and the less-trained staff is appearing to affect patient health. The researcher investigated the number of nursing hours, skill fusion, nursing-related adverse outcomes and identified that the greater the registered nurse's skill fusion, the lower the occurrence of adverse outcomes in the patients. Also, the higher proportions of registered nurses on a hospital staff are found to be correlated to the decreased rates of medication errors and patient falls. Thus, from all the aforementioned research studies, we could understand that nursing staffing is one of the important factors that affect the quality of hospital care.

However, there are also other aspects of the nursing workplace that affect the wellbeing of the patients. A study has found that the lower patient mortality rates were not only because of the staffing ratios but they are also related to nursing autonomy, control over nursing practice, and nurse-physician association. Furthermore, some health care centers have found that the implementation of nursing best practices has improved their ability to hire and retain nurses when at the same time proving to be an economic boon.

Final thoughts

Education and training are the important aspects of best practice. The organization can provide support to the staff through messaging, mentoring, and modeling. With a dynamic shared leadership structure, the data sharing must be allowed, which would then contribute to enhanced outcomes. The partnership with technology experts is also one of the best ways to increase awareness about patient-related risks, medication effects, and other patient status changes. This approach would help nurses evaluate the patients correctly. An organization-wide training program can be conducted to educate nurses about the technology-related changes and to change the culture to one wherein every nurse would take accountability for patient safety. Then, the power of storytelling can be used to engage the hearts of the nurses and to remind them about the adverse events that happen to anyone. This would also promote the culture of lucidity. By this approach, the nurses would learn through each other’s experiences thereby, creating a safer environment as they work in unison.

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